Everyone does it. Why can’t I?

I’m about to burst. Guests: Laryngologist Dr. Robert Bastian and Noel King, co-host and editorial director of the Vox daily news podcast Today, Explained For more, go to http://vox.com/unexplainable It’s a great place to sign up for our newsletter, view show transcripts, and read more about the topics on our show. Also, email us! [email protected] We read every email. Support Unexplainable by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Noam Hassenfeld?

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• 1:18Speaker 02

  Okay.

• 1:18Speaker 03

  All right.

• 1:19Speaker 02

  Are you ready?

• 1:19Speaker 03

  Yeah, let's do it.

• 1:21Speaker 02

  It's Unexplainable. I'm Sally Helm. You are Noelle King here with me in the studio. Hello.

• 1:26Speaker 03

  I sure am. Hey.

• 1:27Speaker 02

  Noelle, you're the host of Today Explained, the Vox Daily News podcast. Congratulations. Wonderful show.

• 1:34Speaker 03

  Thank you.

• 1:35Speaker 02

  To me, you are probably better known as that girl who texts me Onion articles all the time.

• 1:41Speaker 03

  We have known each other for a very long time.

• 1:43Speaker 02

  Yeah, almost a decade, actually.

• 1:45Speaker 03

  No, no, it is a decade.

• 1:46Speaker 02

  It is a decade?

• 1:47Speaker 03

  January 2016. Yeah.

• 1:49Speaker 02

  Oh, my gosh. Wow, like this week.

• 1:51Speaker 03

  This week.

• 1:51Speaker 02

  Okay, well, during our decade-long friendship, there is something that I have never told you about myself.

• 2:00Speaker 03

  There can't be. There can't be.

• 2:01Speaker 02

  No, I think there is. I think there's at least one thing we've never talked about. And I've brought you here today to talk about it. I guess my first question for you is, what is your feeling about medical mysteries?

• 2:16Speaker 03

  Medical mysteries? So as a person who is a self- Diagnosed hypochondriac. I do not enjoy a medical mystery. I want everything medical to be instantly known and understood and clear and taken care of. So when you say medical mystery, I'm not going to lie, I get a little anxious.

• 2:40Speaker 02

  Great. You're not in luck because today we have a medical mystery. That is what we are going to discuss. And first up, I'm going to play you some audio of people discussing the symptoms that they're experiencing.

• 2:55Speaker 04

  You just feel nauseous, you know, after drinking, I guess, one beer or one whatever. Even a glass or two of water can do it.

• 3:04Speaker 05

  Really bad bloating. All the CT scans showed a lot of air in my intestines. But no one knew why and why it wasn't moving.

• 3:14Speaker 06

  It's almost like a dam is holding everything back here in your throat. It's extremely painful and it's very debilitating.

• 3:23Speaker 07

  There were moments where I like, I can't really live like this, where I'm lying in bed at night. And it most felt like I was in this torture chamber of my own body, you know?

• 3:35Speaker 02

  Do you have any guesses right off the bat about, about what's going on?

• 3:38Speaker 03

  This sounds digestive to me. This sounds like something in the old, what we, what we used to call the plumbing.

• 3:46Speaker 02

  You're thinking guts?

• 3:47Speaker 03

  Yeah, yeah, I'm thinking guts. I'm thinking this is a gut issue, but beyond that, no, I don't know.

• 3:51Speaker 02

  Okay, I'm going to tell you more about it.

• 3:53Speaker 03

  Okay.

• 3:54Speaker 02

  But first, I do have to reveal that I actually have this condition myself.

• 3:59Speaker 03

  Oh, girl.

• 4:00Speaker 02

  That we are discussing today.

• 4:01Speaker 03

  I'm so sorry.

• 4:03Speaker 02

  Thank you. Yeah, like the stomach bloating, the weird throat sensations. And there is another symptom that is auditory. People like me who have this condition, we make certain sounds that other people don't make. And I did put together a little medley for you. Some of these are me, some of these are other people with the same condition. Here's some audio.

• 4:25Speaker 03

  Whoa.

• 4:41Speaker 02

  So what did that sound like to you? How would you describe those sounds?

• 4:45Speaker 03

  Okay. Fortunately, fortunately, I laughed through it. So I can't, I can't tell you. I can't tell you exactly what I was hearing there. But actually, I will say, nor do I want to. I don't want to tell you what I was hearing.

• 4:59Speaker 02

  I mean, so a lot of people compare this to a frog sound. There's like a ribbit that can happen. I also have heard, I've heard dinosaur. I've heard monster. I've heard I sound, quote, demonic slash possessed.

• 5:13Speaker 03

  Frog, let's stick with frog. Frog is gentle.

• 5:15Speaker 02

  Frog is good, little ribbit. Okay, I do want to reveal, you said you don't like medical mysteries. I do want to assure you that actually, Noelle, the cause of these symptoms is not, in fact, a mystery.

• 5:28Speaker 03

  Oh, okay.

• 5:29Speaker 02

  The cause of the symptoms is that I cannot burp.

• 5:36Speaker 03

  You can't burp?

• 5:38Speaker 02

  I've never been able to burp.

• 5:39Speaker 03

  Wow.

• 5:39Speaker 02

  Did you know that about me?

• 5:40Speaker 03

  No, no.

• 5:42Speaker 02

  Yeah. Can you burp?

• 5:44Speaker 03

  I can. I'm not going to do it on tape because I'm a lady, but yeah, I can.

• 5:50Speaker 02

  Yeah, I've never been able to burp and it's this really annoying problem. It sounds funny when I tell people because it has the word burp in it. But actually, it's like, there were weeks of my life where I would have to just lie down all afternoon because it was the only way to get comfortable. Yeah. I ended up talking to a doctor who treats this and he was like, there is definitely a range. But some of the patients that I see with this condition have what I would call severe daily misery.

• 6:21Speaker 03

  Oh, gosh.

• 6:21Speaker 02

  From not being able to burp. Yeah. And I mean, I would say that I have not had the worst case ever.

• 6:28Speaker 03

  Okay.

• 6:28Speaker 02

  But you know, it has been bad sometimes.

• 6:30Speaker 03

  Yeah.

• 6:31Speaker 02

  And yet it was also not something that I really thought to mention to people that often, you know? Like, it's weirdly beneath the world's notice. Like, no one ever talks about burping, really? You know, like, when would it come up?

• 6:46Speaker 03

  You're right, there's not like a lot of good options.

• 6:48Speaker 02

  Like, you never told me you are a burper.

• 6:52Speaker 02

  So, all right. The medical mystery is half solved. But Noel, do you think that I called you here to solve a medical mystery in one minute? No?

• 7:00Speaker 03

  No, surely not.

• 7:01Speaker 02

  And there are a couple of mysterious things about this condition. So one of them is just like, why can't I burp? Because I can swallow.

• 7:12Speaker 03

  Yeah.

• 7:12Speaker 02

  And it's the same muscle, you know? So it's like, it can go down to let in food. Why can't it go up to let out a burp? Another mystery is why the medical system has, for some reason, been almost completely blind to this condition. It was only named in the medical literature in 2019.

• 7:31Speaker 03

  Whoa.

• 7:32Speaker 02

  Which, it's like weird to me.

• 7:33Speaker 03

  It's so weird. So many things were identified by 2019. So many things. And this doesn't sound, I mean, you could tell me, it doesn't sound like it's that uncommon? You have all these people on tape saying they're going through the same thing?

• 7:44Speaker 02

  It's really hard to say how common it is. I think it's like somewhat rare, but not like super, super rare. And also, it's just really easy to recognize. Like, it's like, I can't burp. You know? Like, that is the problem.

• 7:55Speaker 03

  Simple diagnosis.

• 7:56Speaker 02

  It's very easy to describe. And yet, yeah, it was not named for many, many years. And that's, it can be like a real problem. Like, I talked to this one woman who you actually heard at the beginning. Her name is Dory Gray. And in her case, the doctors were like completely stumped for years.

• 8:11Speaker 05

  I ended up having every test you can imagine having to do with your intestines. Eventually, the doctors were all like, we don't know. We did every test. We can't figure out why this is all happening to you. Go see the surgeon and see what he thinks.

• 8:27Speaker 02

  And Noel, this woman, Dory, eventually had not one, but two separate surgeons suggest to her that maybe she should just remove her colon.

• 8:38Speaker 03

  Oh, my God.

• 8:39Speaker 02

  To solve her problem.

• 8:40Speaker 03

  Oh, my God, no.

• 8:42Speaker 02

  I know. And thank God she did not do it because now she is pretty sure that the root cause was not like having a colon, but it was actually the fact that she could not burp.

• 8:52Speaker 05

  No one ever said, you know, do you burp? I never thought about not burping. It just wasn't on my radar as a thing.

• 8:59Speaker 02

  Dory did eventually do something to try to solve this problem at its root. And that brings us to mystery number three, which is a really good one. Because for some people, there is now a mysterious, but possibly permanent cure.

• 9:12Speaker 03

  Oh.

• 9:13Speaker 02

  And I have just recently tried it in an attempt to finally learn to burp.

• 9:19Speaker 03

  Okay.

• 9:19Speaker 02

  So I'm gonna tell you that story today. Are you ready?

• 9:21Speaker 03

  Yeah, let's hear it.

• 9:39Speaker 02

  Our main character today is a hero to all no burpers everywhere. And his name is Dr. Robert Bastian.

• 9:46Speaker 03

  Okay.

• 9:46Speaker 02

  He is a laryngologist in Illinois. And I'm gonna play you a little, a little tape to help you get to know him better.

• 9:52Speaker 06

  My mind is one that goes to sort of solutions. And so I've done some of those online inventories, you know, StrengthsFinder and Colby.

• 10:01Speaker 02

  Noel, you know that I love a personality test.

• 10:02Speaker 03

  Oh, I love a man who looks for solutions.

• 10:05Speaker 06

  I've learned that about myself, that I'm a strategic thinker, I'm an optionizer. And I'm also a physician who leans to the observational side. You know, the scientific method is to test a hypothesis based in observation or measurement. And so what I would say about the medical profession is that it leans heavily towards measurement. So sometimes I say, when I teach, I say, you know, measurement gets respect. Observation does not get respect.

• 10:37Speaker 02

  But Dr. Bastian is a real listen to the patient kind of doctor. Like, he doesn't like to get bogged down in unnecessary details. He doesn't want to run a zillion tests if that's not necessary. I mean, not that he's not interested in facts. He does also run a website called Laryngopedia, which is a voice and swallowing disorder encyclopedia. And one day, Noel, he gets an email from a guy in Texas, who says, "Can you help me, Dr. Bastian, because I cannot burp? It has been a lifelong problem." But he is moved to send the email at that moment, because he had also picked up a new hobby that was making not burping especially difficult.

• 11:22Speaker 02

  Do you want to guess what it is?

• 11:23Speaker 03

  Drinking soda?

• 11:26Speaker 02

  Good guess. Totally wrong. The new hobby was skydiving.

• 11:32Speaker 06

  So he said when he goes up in the airplane, he just becomes incredibly uncomfortable. Other people are burping and he couldn't burp.

• 11:39Speaker 02

  Wait, so wait, this is now a tangent. But when you go up in an airplane to skydive, that causes you to burp for some reason?

• 11:46Speaker 06

  Well, have you ever noticed that the potato chip bags get really puffy when you go up in the air? So because he had a lot of air in his stomach and he needed to burp it out, he couldn't do that. He said he became incredibly uncomfortable because his stomach became like that potato chip bag.

• 12:02Speaker 02

  Over the years, he's seen all these doctors. No one can figure it out. But now he wants to be a skydiver. So he really goes deep and he finds his way to Laryngopedia and to Dr. Bastian, who it turns out is like the perfect person to talk to here. Because he works a lot with this particular swallowing disorder that has to do with the muscle that is clearly involved here, which is the upper esophageal sphincter muscle, also called the cricoferingius muscle. It's like a circular muscle that opens and closes. And, you know, for normal people, you're probably familiar. Air will come up your throat. It will present itself to this muscle and then the muscle relaxes and the air comes out. And for this person and for me, that is not happening for some reason.

• 12:47Speaker 02

  So our problem is that the muscle is not relaxing properly and maybe even is clamping up. So Dr. Bastian, he's familiar with this muscle and he also, as we've discussed, has this very particular personality and this like particular medical style where he leans towards observation. And so just getting this email where this guy is describing his own observations very clearly. Here is my problem. The problem is I cannot burp. Here's what it feels like. Here's what happens to me. And Dr. Bastian, like, that is giving him a lot of information. He's like, OK, it sounds like this guy knows what the problem is. Tick, tick, tick through the possible solutions in his mind. And like, he actually pretty immediately comes up with an idea.

• 13:33Speaker 06

  I said to him, well, you need to have somebody put Botox into your upper esophageal sphincter to help you burp.

• 13:38Speaker 03

  This actually makes complete sense to me, baby, because when you think about it, Botox, they use Botox to freeze all kinds of things, right?

• 13:45Speaker 02

  Exactly.

• 13:46Speaker 03

  Yeah, yeah, yeah. Okay, smart man.

• 13:48Speaker 02

  You know, you use it between your eyebrows or whatever so that you don't get wrinkles there because the muscle can't move.

• 13:52Speaker 03

  Right.

• 13:53Speaker 02

  And so, exactly, he's like, this will paralyze the muscle and then this man will have no choice but to burp because the muscle can't clamp up in this, in this way. And in fact, he has actually injected Botox into a nearby part of the body, the larynx.

• 14:07Speaker 06

  I do 100 injections a month for a rare neurological condition of the voice.

• 14:13Speaker 02

  Wow, does that work for that disorder?

• 14:14Speaker 06

  It works beautifully, beautifully for that disorder, just beautifully. And so, in all those people, they come two to three to four times a year and repeat the, the treatment.

• 14:25Speaker 03

  He's done it before, it's not like it's dangerous.

• 14:27Speaker 02

  Right, yeah. So Dr. Bastian is like, okay, like, I'm gonna inject this guy with Botox, that'll get him burping, and then when it wears off, because it wears off in like three months, I'll just do it again and he can just burp for the rest of his life. So he does this, he sends him on his way. And then Noel, other people start showing up in his office. Because unbeknownst to him, this guy has been posting about his experience on the internet and there is this thriving no burper community on Reddit and Facebook where people are being like, I can't burp, the doctors are telling me to remove my colon, like, what do you guys think we can do? And these patients have a very particular symptom cluster that Dr. Bastian starts to recognize.

• 15:11Speaker 02

  So obviously, can't burp, chief among them, bloating, the gurgling. A lot of people experience a higher level of flatulence for obvious reasons.

• 15:20Speaker 03

  Oh, no.

• 15:21Speaker 02

  There are a few random things like painful hiccups. Are your hiccups painful?

• 15:26Speaker 03

  No, they're annoying, but not painful.

• 15:28Speaker 02

  Yeah, mine have always been painful. I did not know until college that that was like not normal. Another interesting thing is that more than the general population, we know burpers tend to have a meta-phobia, which is a fear of throwing up. What do you make of that?

• 15:43Speaker 03

  I, my sister and my niece have emetophobia. It is not a game. I am wow.

• 15:48Speaker 02

  You should check if they can burp.

• 15:50Speaker 03

  You're giving me all kinds of ideas right now, yeah.

• 15:52Speaker 02

  Yeah, well, so, okay, so I saw one study that raised the idea that people who can't burp might be subconsciously tensing this muscle. So I was like, maybe you're tensing that muscle because you're scared to throw up. And yeah, you don't throw up, but also you can no longer burp. But Dr. Bastian told me another theory, which is that throwing up can actually be painful if you have this condition. So maybe it goes the other way, where early on you had a painful experience of throwing up, and then that actually causes your emetophobia, not the other way around.

• 16:27Speaker 03

  That is incredible. It is, and also babies throw up. So it does strike me that you could very early on be a baby. Babies throw up a lot. You're having this reaction, you're feeling as a baby pain. And so you're, you know, you get older, you're not putting two and two together, why am I afraid of throwing up? Oh, because I don't remember being an infant. Yeah, wow.

• 16:46Speaker 02

  I mean, that's basically Dr. Bastian's theory, although he's like, I don't know. Like, I don't know if that is true. I will say, some of us, no burpers, could not burp as babies. Like, there's stories of you just, like, can't burp at all. I know. I, I had colic as a baby, so I was, like, crying all the time. And Dr. Bastian was like, you were probably an inadequate burper. Like, you probably could burp, but not quite right.

• 17:09Speaker 03

  Yep.

• 17:10Speaker 02

  Okay, so anyway, so, so he's getting this sort of symptom cluster. He's trying to figure it out as best he can, but eventually he's like, I should go read the literature on this. Like, I should just go see what people have written.

• 17:20Speaker 06

  And to my great surprise, there was essentially nothing.

• 17:26Speaker 06

  I was astonished. I thought, I didn't think there was anything left to discover. Or, you know, once you know about it, it's so obvious.

• 17:34Speaker 02

  Totally.

• 17:34Speaker 06

  But that's the problem with a lot of things in life. Things aren't obvious sometimes until they're obvious.

• 17:41Speaker 02

  Dr. Bastian does publish a paper on this in 2019. He names the syndrome, and I call it no burp syndrome. That's what the Reddit is called, but its official name is Retrograde Cricoferengius Dysfunction, RCPD.

• 17:55Speaker 03

  I have mixed feelings about Reddit, but in this case, you have a bunch of people who are all suffering from the same thing. And it's not like there wasn't anything.

• 18:03Speaker 02

  And he actually had some interesting, specific theories about why medicine missed this. And one of them is like, interestingly logistical. He was basically just like, I mean, your first instinct was this is a gut-related thing. And a lot of people end up with GI doctors if they have this condition. But this muscle is at like, the top of anything a GI doctor would think about. But it's at the bottom of anything an ear, nose and throat doctor would think about. So he's like, it's kind of an orphan area, he called it. Like, it just like gets a little lost. No one's really thinking about it. And then the other thing I thought was so interesting, it goes back to his whole thought about like, observation being a little bit maligned or like, not taken seriously.

• 18:47Speaker 02

  Because like, this is what he would call a syndromic diagnosis. So there's no like, one test that you can just do when someone walks into your office. It's just like, you talk to the patient, do they have this cluster of symptoms? Which, again, is like, pretty obvious. And at this point, in the year 2026, his practice has treated about 2,400 people who can't cope.

• 19:12Speaker 03

  Wow.

• 19:17Speaker 06

  Just as a wild guess, taking it out of the air, I would imagine that there must have been at least 15,000 major tests done on these 2,400 people before they came to us.

• 19:28Speaker 02

  Wow.

• 19:29Speaker 06

  So they've had barium swallows, they've had bolus entography, they've had stool cultures, they've had upper GI scopes, they've had colonoscopies, they've had everything imaginable. And out of those 2,400 people, the diagnostic rate was exactly zero. All that testing and nary one single diagnosis.

• 19:52Speaker 02

  And on the other hand, every single person he has seen who has diagnosed themselves as a no burper on the internet has been correct. Out of this like 2,400 people, except, except he did say there was literally one guy who just seemed like not really paying attention to the details. He was like, no, you don't have it.

• 20:10Speaker 03

  Different issue.

• 20:11Speaker 02

  But like basically 100%.

• 20:13Speaker 06

  So when I teach on this subject, I say to doctors, if patients can diagnose themselves accurately 100% of the time, then why can't we doctors do the same?

• 20:27Speaker 02

  There have now been a couple of studies that do testing to confirm that this condition is real. They put a like fricking catheter through your nose and do like a pressure sense down your throat to see if you're burping. And I emailed with one of the authors and he was like, yeah, I really, I didn't think this was a thing, but then our study did confirm it.

• 20:46Speaker 03

  Incredible.

• 20:47Speaker 06

  And so two studies have said, wow, these people can't burp, to which the patient would respond, yes, I told you that already.

• 20:57Speaker 02

  Right, that's why I'm here.

• 20:58Speaker 06

  But it is nice. We've got now proof of the disorder, but my comment is, okay, thank you very much for proving this for us, but now don't hassle people. You don't make new individual patients submit to that test, that very obnoxious test.

• 21:16Speaker 03

  That feels right to me.

• 21:18Speaker 02

  And like this thing about observation and measurement, like I, it does make sense to me, like, what are your just off the cuff theories of why doctors are generally ordering tests?

• 21:28Speaker 03

  Okay, so I, I have two theories. One of them is that doctors know that there are people like me who diagnose themselves on the internet, come in and say, I have this very rare disease. And they're like, no, Noel, as a matter of fact, you don't. You're paranoid. You're a hypochondriac. So that's one. The second thing is, I imagine there is some, um, imagine there's some financial incentive here when it comes to testing people, people pay for tests, et cetera, et cetera. And I don't want to be cynical or suggest that like, you know, the medical profession is out to get us, but whenever there's money involved, I get curious about like who's making it and who's paying it.

• 22:03Speaker 02

  Sure. Or even just like the prospect of getting sued is something I was thinking about.

• 22:06Speaker 03

  Oh, yeah.

• 22:07Speaker 02

  Like, I'm sure if you get sued one time, then you're like, oh my God, I'm never gonna not order, you know, like you just.

• 22:11Speaker 03

  Right.

• 22:12Speaker 02

  I will say Dr. Bastian did seem pretty sympathetic to the internet diagnosis thing in general.

• 22:17Speaker 03

  Heck, yeah.

• 22:17Speaker 02

  I think it's true that sometimes people get themselves into a lather. But he's also like, you know, it's kind of great. You you get a little further on your own diagnosis. It's usually pretty clear to me whether you're right or wrong. Like, it takes me one second to like, talk to you about that. And he did also say, though, he was like, I do think medicine like over indexes on fact finders, just people who really want to pin down all the details. They're like trees, people, not forest people.

• 22:45Speaker 03

  Yeah.

• 22:45Speaker 02

  And med school is really like that. You know, it's like this like fire hose of facts. And he's like, maybe it just kind of draws people who are into that. But he's putting in the plug for observation, you know, like it's part of the scientific method, too.

• 22:57Speaker 03

  Good for him.

• 22:58Speaker 02

  And he thinks people should respect it.

• 23:00Speaker 03

  People know themselves.

• 23:01Speaker 02

  Mm hmm. And Noel, do you remember our Texan skydiver who got the Botox?

• 23:06Speaker 03

  Yes.

• 23:07Speaker 02

  And Dr. Bastian was expecting him to come back in a couple of months for another round. But Noel, he mysteriously kept burping.

• 23:18Speaker 03

  It like it worked and then just kept working?

• 23:21Speaker 02

  In fact, it did. And as far as I know, he is still burping.

• 23:24Speaker 03

  Huh.

• 23:25Speaker 02

  And all these other patients who Dr. Bastian was treating, a huge number of them also kept burping beyond the three to four months.

• 23:33Speaker 06

  So I thought, all right, well, now I have to figure out why on earth would a single Botox injection fix these people permanently? This does not make sense.

• 23:44Speaker 02

  It does not make sense.

• 23:45Speaker 03

  It doesn't make sense, yeah.

• 23:46Speaker 02

  And yet, obviously, if you're me, you want to try it, right?

• 23:50Speaker 03

  Oh, yeah, immediately, today.

• 23:53Speaker 02

  So in November, I went to get the Botox to see if I am among the pretty large group of people for whom it might be a permanent cure.

• 24:07Speaker 03

  Wow.

• 24:08Speaker 02

  And that is after the break.

• 24:17Noam Hassenfeld?

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• 24:23Noam Hassenfeld?

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  Sonos: Love the sound, feel the system.

• 25:57Speaker 01

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• 26:31Speaker 03

  First, you might discover a video about the Andromeda Galaxy. And then, next thing you know, you're learning how to find different stars, or how to identify constellations, or how different astronomical discoveries got made, or how constellations got their names. You don't need serious equipment to make serious discoveries. Start with a simple question, and suddenly, you're somewhere you never expected to be. Your next discovery is waiting on TikTok. Learn more at tiktok.com/discovermore. At tiktok.com/discovermore.

• 27:13Noam Hassenfeld?

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• 28:01Speaker 03

  What happened to the car? Don't ask me, ask him. Hi. Excuse me. I'm so excited. I'm so excited.

• 28:12Speaker 02

  You're getting the talks. I'm getting the talks. You did say you would go for this immediately?

• 28:19Speaker 03

  Yes.

• 28:19Speaker 02

  I dragged my feet on this for years.

• 28:22Speaker 03

  What?

• 28:22Speaker 02

  But eventually, I was like, look, there is no single other problem in my life that I can solve with one injection. And like, I'm gonna do it. So in November of last year, I went for it. It's about 4:30 a.m. My alarm just went off. So I did do this in the operating room, under general anesthesia. I'm not supposed to have any food or water. This is a reminder to myself. They also told me that I had to take two showers, Noel, I guess for germs in the operating room. It was intense. You can just do it in the doctor's office. The needle just goes in through your neck, but that is not as precise. There can sometimes be voice-related side effects, which wouldn't be great for me. So anyway, I ended up doing it in the operating room,

• 29:05Speaker 02

  which means, you know, got to the hospital, went up to the surgical floor. Third floor. Going out. I got my gown. All right, they took my vitals. Heading in soon. I didn't have my phone with me for the surgery, obviously, but the vibe was like really jolly. The anesthesiologist was this funny guy. I go to sleep, I wake up. It takes five minutes. They did intubate me to protect my airway. Yeah, and then they just inject botox into this muscle at the top of my esophagus. Okay, I'm out. It went well. I'm in the recovery room. Little sore throat, but everything seems good.

• 29:48Speaker 02

  I'm not even that groggy. Hopefully burps soon. What questions do you have at this moment? What are you wondering?

• 29:57Speaker 03

  Well, first, I heard you say it was 4:30 in the morning, and I feel bad because I know you don't like to get up early. Second, I will say you are one of the least decisive people I've ever met. So actually, it does, it totally tracks to me that you learn about this and then years later, you're like, I'll get this done. But now, but now you did it. You did all the things you need to do. And now I just want you to test it out. I'm like, but do you know? One question I have genuinely is, do you know how it works? Do you know that you have to like, kind of like gulp air in? And then, like, do you know how to do that?

• 30:25Speaker 02

  That is such a great question. So, okay, we're gonna get to that. Basically, I mean, my question is, I was like, am I gonna be burping uncontrollably immediately?

• 30:34Speaker 03

  Oh.

• 30:35Speaker 02

  Because I've never done it, you know? And I'm like, it's embarrassing. I'm gonna be like, can I go to work? Like, what's gonna happen? And I did read a, I'd read a Johns Hopkins, like, Explainer about it. And it was like, in the first couple of weeks, you will be burping exuberantly.

• 30:50Speaker 03

  Oh.

• 30:51Speaker 02

  I was like, oh, no. But it is not immediate. It does take a few days, usually, to kick in.

• 30:59Speaker 03

  Okay.

• 30:59Speaker 02

  So like, in the 48 hours after the surgery, I'm just watching every movement in my throat. So I left my phone running while I was working.

• 31:07Speaker 03

  Yeah.

• 31:07Speaker 02

  Here's some sound.

• 31:20Speaker 02

  My God. What does that sound like to you?

• 31:23Speaker 03

  I mean, it's the croaking from the beginning. We're gonna say frog. Frog is gentle.

• 31:28Speaker 02

  Right. I was still, it was still frog sound, but like, I could feel that it was like, getting ready. So, okay. So it's two days after the surgery. That night, I had had dinner with my friend, John. I was walking down the street. I was in the middle of talking about something. And suddenly. John, what just happened?

• 31:48Noam Hassenfeld?

  I heard a belch.

• 31:49Speaker 02

  You heard, you did, like that?

• 31:51Noam Hassenfeld?

  Yeah, a legit belch.

• 31:52Speaker 02

  That was one?

• 31:52Noam Hassenfeld?

  Yes.

• 31:54Speaker 02

  Oh, my God. Really?

• 31:56Noam Hassenfeld?

  Yes, it came from deep inside you.

• 31:58Speaker 02

  Oh, my God. But it was like, while I was talking?

• 32:02Noam Hassenfeld?

  Yeah.

• 32:02Speaker 02

  Like that, kind of? Oh, my God, that was kind of a burp.

• 32:05Noam Hassenfeld?

  No, now I think you were thinking too hard for it.

• 32:10Speaker 03

  Noelle, what do you think? John is so game. He's so game. He's like, I'm here for you, girl. I'm proud. What I feel right now is proud. I feel like you did it.

• 32:18Speaker 02

  Thank you so much. I mean, it's so funny to listen back, because I, obviously, I cannot hear whatever things I was experiencing as burps in that moment. But like, it felt like I kept burping while talking. And that was really a feature of the next couple of days, because to me, any burp seemed so loud and surprising. In my head, I had never experienced this. So like, the next night during dinner with friends, I kept burping, but what it looked like to them was that I was just stopping in the middle of talking and like, making this incredibly surprised face.

• 32:50Speaker 02

  Okay, so tell me about, oh, yeah.

• 32:53Speaker 02

  That was a burp to me. Was it to you guys?

• 32:55Speaker 04

  It was really, it wasn't perceptible on any level. It was. It was just a look of shock.

• 33:01Speaker 02

  But there was no sound or.

• 33:04Speaker 03

  All right. There was a little sound, I promise, but that's great to know.

• 33:07Speaker 02

  You guys haven't had this experience the whole time?

• 33:09Speaker 03

  Yeah, it's crazy.

• 33:10Speaker 05

  I just did it. I just burped and nobody was aware.

• 33:13Speaker 01

  Cause I think what happens is like you feel it coming and you like, either, either you like finish saying what you're gonna say or you go, excuse me, and then you continue. Like I feel like people do this all the time, like in, Yeah. like interviews and podcasts and stuff, people will like pause for a second because they're burping.

• 33:29Speaker 02

  Right.

• 33:29Speaker 03

  Whoa.

• 33:30Speaker 01

  That was.

• 33:33Speaker 05

  We have no inhibitions.

• 33:34Speaker 01

  I, I have no control.

• 33:40Speaker 02

  Wow, if you didn't catch it, I said, I have no control and I burped on the word control.

• 33:45Speaker 03

  You have a very supportive community.

• 33:47Speaker 02

  I really do, thank you. One thing, it really was so interesting to me that everyone has just been secretly burping around me all this time. Like, have you burped while we've been talking?

• 33:57Speaker 03

  I have not while we've been talking, but like when your friend said, like, if you're doing a podcast interview or something, like you just sort of like, say, excuse me, or hold on a second. Yes, of course, I talk for a living. I do that all the time.

• 34:09Speaker 02

  It's so funny because I actually, I had the experience a bunch of times where I would be telling people about what I was going through burp wise and they would be like, oh, I never burp. And then later in that conversation, they would be like, oh, I just burped.

• 34:19Speaker 03

  Like I think you don't pay attention to it. You don't realize it until someone brings it to your attention and tells you like, I can't actually do this. And then you're like, oh, wait, no, I do this all the time.

• 34:29Speaker 02

  Exactly. Like all the time. So in the weeks after the surgery, I was burping a lot. I was not in control. Like, for example, three weeks after the surgery, I was out to dinner with my sister and my college friend Margaret. And I burped.

• 34:49Speaker 02

  Okay, but then I started laughing and then the last came burp.

• 34:59Speaker 02

  That's been lovely. What do you think? I'm so proud of you, mama. Thank you. Okay, so I did start to get a little bit better at it, like get a little bit more control. I discovered that a body posture that worked really well is, you know, when you're reversing a car and you put your arm out over the passenger seat and you like turn your head over your shoulder? So I did that and it was just like burp city right away. Backing up in the car.

• 35:33Speaker 02

  Oh, my God. Why is it like this? I literally didn't even know I had to burp.

• 35:40Speaker 02

  Okay, so also often during this time, I would like get into this really weird position. Like I would, I would do the basically like backing out in the car thing, but I would put my arm on the wall and then I would like turn my head around and like dip my chin and crank my head. Um, my family was very supportive, but they were also confused. Like I burped while I was hanging out with my sister and my dad. Are you proud of me? I was a real burp! I just did a little sputter burp and you heard, do you proud? Oh, my God, yeah, but why did you have to do it in that weird contortion? I have to make them come out.

• 36:11Speaker 02

  Wow.

• 36:19Speaker 02

  That was such a weird one!

• 36:21Speaker 03

  Did it come out?

• 36:22Speaker 02

  Yeah, well. Look at this.

• 36:24Speaker 03

  What, what I am sort of shocked by, in all honesty, is that you went, we're not gonna age ourselves, but you went 30 some odd years without being able to do this. One surgery and like fixed?

• 36:40Speaker 02

  Yeah, I mean, so number one, it might not work permanently for me. Like it doesn't work for everyone. Um, and also it's only been around for about 10 years, so it remains to be seen whether it can last forever. But as of now, there are a lot of people who did the Botox and can still burp. So I did talk about this with Dr. Bastian, right? Because I was like, what is going on here, right? Like, why is this happening?

• 37:06Speaker 03

  Yeah.

• 37:07Speaker 02

  I did actually burp on the call with him.

• 37:10Speaker 03

  Good.

• 37:14Speaker 06

  That was a good one.

• 37:15Speaker 02

  Thank you, Dr. Dr. Bastian.

• 37:17Speaker 06

  It just turned a little bit, so.

• 37:19Speaker 02

  So that's good, so I'm getting there.

• 37:20Speaker 06

  And you opened your jaw, but that lowers your larynx, I think. So think about lowering your larynx. Work on that one.

• 37:27Speaker 02

  Okay, so this was very interesting to me. He was really adamant that I needed to be consciously practicing. And I'm supposed to find the little posture that makes me burp.

• 37:38Speaker 06

  So every person who burps does something just prior to the burp. So there's a gesture, there's a fidget, there's a, I don't know what to call it. But I don't like calling it the Belch reflex because it does have some voluntary input. So that's the idea. It's like, I need to figure out what can I do not to force it, but to invite it.

• 38:02Speaker 02

  Do you have one of these, Noel? Does this resonate for you?

• 38:05Speaker 03

  I don't think so, but I will tell you that it's not something that I've ever thought about.

• 38:11Speaker 02

  I mean, this is interesting. He said, he was like, many burpers are not aware of it. Like, they feel like they're doing something without any involvement of theirs. But actually, they are doing something, like there's like a ab thing or like move your shoulders. And basically, his theory is just like, everyone actually needs to do this to invite the burp. And for whatever reason, some subset of human beings, which includes me, just early on in their lives, like, didn't learn how to do this, or they learned it wrong. And that is basically also his theory for why Botox might be able to permanently cure the problem.

• 38:47Speaker 06

  Why are people still burping? My answer to that has to be, well, they figured it out.

• 38:54Speaker 02

  So his theory is that, you know, Botox paralyzes this muscle, and that gives you the opportunity to learn the skill of burping, and then that learning sticks. And Noel, I am now about 11 weeks out from the surgery. So I am coming to the end of this window where Botox is helping me burp. The training wheels are about to come off. And I really gotta hope that all the practicing that I have been doing is gonna carry me through. I have been drinking a seltzer while we've been talking. Should I, should I give it a try?

• 39:28Speaker 03

  Yes, you absolutely should.

• 39:29Speaker 02

  Okay.

• 39:38Speaker 03

  It's so good. It is so good.

• 39:40Speaker 02

  I really hope it lasts. Here's hoping. I'll let you know.

• 39:49Speaker 02

  Really big thanks today to Noelle King, host of the podcast Today Explained. And if you are not listening to that podcast, what are you even doing? You should go subscribe to it right now. Another very, very special thanks today to everyone from r/NoBurp, who sent me their stories and their gurgles and who agreed to be interviewed about our CPD. You heard the voices of Anders Bjirknes, Dory Gray, Matthew Dull, and Elina Lin. I so, so appreciated hearing from absolutely everyone who wrote to me. Thank you so, so much. This episode was produced by me, Sally Helm. It was edited by Jorge Just with help

• 40:30Speaker 02

  from Joanna Solotaroff. Joanna also runs the show. This episode was sound designed by Christian Ayala and fact-checked by Melissa Hirsch. Noam Hassenfeld did the music. Amy Padula, Meredith Hodnot, and Julia Longoria all know how to burp. And Byrd Pinkerton was like, what? White room, station, sun doesn't shine, but the shadows run from themselves? She had no idea where to find Eric Flapton. But then she remembered, Flapton was a bird, and she had a beak beeper.

• 41:09Speaker 02

  Thanks, as always, to Brian Resnick for co-creating the show, along with Bird and Noam. And if you have any thoughts about this episode, we are at [email protected]. I will say, if you think you might be a NoBurper, you are probably right, and I would love to hear from you. If you want to support the show and help us keep making it, please join our membership program at vox.com/members. You will get ad-free podcasts and other perks and unlimited access to Vox journalism. You can also support us by leaving a nice rating or a review, or by telling people you know to check out Unexplainable. Unexplainable is part of the Vox Media Podcast Network, and we will be back in your feed very soon.

• 42:02Noam Hassenfeld?

  Support for the show comes from Sonos. No matter how much you know about frequency response or harmonic distortion, the thing that's going to make you fall in love with a speaker is how it makes you feel. And Sonos has that it factor, you know? It's this seamless system that makes things sound good in every room. That obviously takes some serious engineering, but it also takes a big-picture understanding of how and why we actually listen to things. The birthday playlist, the new TV show, the exciting new game you just got. And for the nerds out there, Sonos does have amazing frequency response and extremely low harmonic distortion. Visit sonos.com and build your system.

• 42:44Noam Hassenfeld?

  Sonos: Love the sound, feel the system. Support for the show comes from JIRA by Atlassian. Your work lives in scattered places, and it's not only your team searching for context, your AI agents need it too. JIRA taps Atlassian's teamwork graph to bring that context together across JIRA, Confluence, Slack, GitHub, and more, and makes it easy to share with the agents you already use, like Claude, Purser, and GitHub Copilot. Assign them work directly, or connect your agents through MCP. Spend less time hunting for context, less time asking, "Wait, what did we decide?",

• 43:27Noam Hassenfeld?

  and more time actually shipping with JIRA. Learn more at jira.com. That's J-I-R-A dot com.